Marilee Benson is president of Zen Healthcare IT, a technology provider that aims to simplify interoperability with a flexible healthcare data exchange platform and on-demand data exchange specialists. Zen’s Gemini integration platform addresses many healthcare interoperability needs, including simple API access to over 600,000 providers across a national data sharing network.
With more than three decades of experience in health IT, Benson is an expert on the interoperability needs and challenges faced by hospitals and health systems of all sizes. She is passionate about leveraging technology to improve patient outcomes and is a recognized leader in the healthcare interoperability community, currently serving on the Carequality Advisory Council.
Healthcare IT News spoke with Benson to discuss the impact of interoperability on hospitals and health systems, strategies for overcoming common challenges in healthcare data exchange, the role of technology and interoperability in improving patient outcomes, and the future of healthcare interoperability.
Q. How does interoperability benefit hospitals and health systems?
ONE. The most important impact of interoperability on hospitals and health systems is the direct impact on improving the patient experience. I recently read an article that said improving the patient experience is a top priority for hospital and health system leadership.
That makes sense, as we’re entering a period where patients have more and more choices about where they seek care, including more virtual options. To compete in this more complex healthcare ecosystem, hospitals and providers need to ensure they’re delivering a great patient experience.
On the other hand, patients and caregivers continue to feel frustrated by moving between different healthcare settings and having their important information follow them throughout their healthcare journey. Hospitals and health systems that want to prioritize the patient experience are focusing on this aspect now or will soon need to.
And just “going Epic” isn’t enough. The Silver Tsunami we’re hearing about means a patient is more likely to be in and out of multiple health care facilities for multiple conditions.
And, even if you’re not silver lining yet, you probably have aging parents. Focus on ensuring seamless data flow between all the different healthcare settings through Focusing on healthcare interoperability is a core requirement to improve the patient experience.
When I talk about improving the patient experience, I also mean improving patient outcomes. Health systems are investing in promising technologies to improve patient outcomes – specifically purpose-built AI, which finally seems to be delivering on its promise to improve health outcomes. While it’s still early days, I don’t see the AI trend in healthcare slowing down in the next five years.
These promising AI tools don’t work without data, which again brings us back to the critical need for better interoperability between different systems.
Q. What are some strategies that can help overcome common challenges in healthcare data exchange?
ONE. The biggest trend today in overcoming challenges in healthcare data exchange is strategies that replace do-it-yourself approaches with outsourced interoperability expertise/managed platforms.
We are seeing this strategy deployed for both traditional direct data exchanges – the “basic” healthcare data exchange use cases – and broader community-based exchanges through legacy IHE-style connections, which have driven nationwide data exchanges for years to share treatment-based data.
FHIR is no exception to this trend. FHIR has many of the same issues as other healthcare data standards, including multiple versions and implementation guidelines, and most importantly, FHIR needs to coexist with older standards.
Examples of traditional interfaces include lab order/results interfaces, radiology orders and results, or feeds that send admission/discharge data to your local health information exchange. A managed platform approach can allow a single EHR data connection to route to multiple other systems that need the same data, saving time and money – and reducing the number of point-to-point connections that must be managed over time.
Additionally, as health systems continue to look to outsource core IT functions as a way to save costs and increase efficiency, the platform-plus-expertise approach begins to make sense. What is the cost of maintaining a team of interface/interoperability engineers over the long term? And for smaller organizations, what is the cost and disruption when an interoperability expert leaves?
To share data more broadly with the healthcare community, we see providers and health systems looking for ways to improve the provider experience – and therefore the patient experience. Providers are looking for better ways to receive and process data from outside their practice or facility to better support referrals and care transitions.
Purpose-built managed platforms for this type of widespread data sharing are beginning to show that they can optimize these chart review/referral processes, now with more ways to plug into regional or national data exchange networks. These platforms can act as pure middleware, using automated processes to retrieve data and send it to the EHR, or provide purpose-built user interfaces optimized to visualize data coming from external sources much more efficiently than a typical EHR system.
The emergence of non-EHR-based systems that are optimized for data queries has led to a new use case for nationwide data exchange. Under the Carequality Trusted Exchange Framework, this is referred to as the “on behalf of” use case.
The idea here is to use a different technology to initiate the national network query, versus the EHR, which acts as the responding entity, since it is the source of truth for the patient’s complete medical record. This same concept is also applied in TEFCA, just using a different name.
Q. What is the role of technology in improving patient outcomes? And how does interoperability play a role here?
ONE. Since the possibilities for technology to improve patient outcomes seem limitless to me, I’ll focus on just one very important use case: individual access to healthcare data.
Most people today rely on technology to organize almost every aspect of our lives. I rely on the calendar on my phone to know what meetings are coming up next. I rely on travel apps to store and view my travel-related information.
The same is true for our health. I use an app to remind me to take my medication and even an app to check my hearing. I use the patient portal a lot and like many people, I hate having to log into multiple patient portals.
I have a family member in the hospital right now. It’s incredibly frustrating not being able to access their medical records because the hospital doctors are asking me questions I can’t answer. When we can’t answer health history questions in an emergency, our loved ones’ care suffers. Technology can solve that problem for us – we just need to go beyond patient portals that are connected to the EHR. And that’s where interoperability comes in.
Individual access – also known as patient access – to our health data is one of the most difficult interoperability issues to solve. And, frustratingly, it’s not a technology issue. National networks like Carequality, eHealth Exchange, and Commonwell Alliance has created implementation and pilot guidelines related to patient access.
The issue is adoption – the willingness of hospitals, health systems, and providers to adopt electronic patient access as a mandatory data sharing use case. But two important things have changed, and that brings us to what I think is the biggest next step in enabling interoperability to have an even greater positive impact on health outcomes.
This brings us to the future of interoperability in healthcare.
Q. What does the future of interoperability in healthcare look like?
ONE. TEFCA, the government’s trusted data exchange framework, will be a huge driver for the future of healthcare interoperability. While private national networks have been very successful in clinical-based exchanges (Carequality participants are sharing nearly 1 billion clinical documents per month), there are still significant gaps, the most important of which is individual access, as I mentioned earlier.
But TEFCA has succeeded in making individual access a mandatory communication goal for health care organizations when raising questions about treatment.
Adding to this recent major change Epic announced that it is requiring all of its customers to move to a TEFCA-based exchange by the end of 2025 – through Epic Nexus, a qualified health information network, or QHIN, according to TEFCA. Now you have all the ingredients for individual access to achieve widespread adoption.
Epic represents a large number of hospitals and providers, and this move will be a catalyst for other EHRs, HIEs, and health technology vendors to also transition their vendors to a TEFCA-based exchange.
This means that by the end of 2025, we will all be able to use a TEFCA-eligible health app to access the TEFCA data exchange framework – and be able to do a single query to get all of our important medical histories into an app of our choice. This will help us all better manage our own health information, which I think is the most important missing piece for technology to truly improve health outcomes.
At the end of the day, the decisions we make every day of our lives have the biggest impact on our long-term health.
Stepping back a bit to look at healthcare data exchange in general, I don’t believe TEFCA will eliminate the need for other types of interoperability like direct point-to-point interfaces. There will always be a need for different types of direct interfaces, using different healthcare data standards, because those standards and use cases aren’t going away.
But if we each have a complete health record in our pocket, we open up a whole new avenue for caregivers to access our data at key moments in our health journey, without having to rely on what we or our family members can communicate or remember.
Personally, I remain committed to making every use case of healthcare interoperability simpler, safer, and easier. However, I am most excited about the positive impact on health when making individual access a routine part of healthcare data exchange.
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